Affiliation: Division of Brain Sciences,Department of Medicine,Centre for Mental Health,Imperial College London,London,UK.

ABSTRACT

Background: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by high rates of co-morbid psychopathology. Randomized controlled trials of multimodal interventions, combining pharmacological and psychological treatments, have shown a robust treatment effect for ADHD symptoms but outcomes for co-morbid symptoms have been mixed. This may be accounted for by the type of intervention selected and/or by methodological problems including lack of follow-up and low power. The current study addressed these limitations in a parallel-group randomized controlled trial conducted in Iceland.

Method: A total of 95 adult ADHD patients who were already being treated with medication (MED) were randomly assigned to receive treatment as usual (TAU/MED) or 15 sessions of cognitive-behavioural therapy (CBT/MED) using the R&R2ADHD intervention which employs both group and individual modalities. Primary measures of ADHD symptoms and severity of illness, and secondary measures of anxiety, depression and quality of life were given at baseline, end of treatment and 3-month follow-up. Primary outcomes were rated by clinicians blind to treatment condition assignment.

Results: CBT/MED showed overall (combined outcome at end of treatment and 3-month follow-up) significantly greater reduction in primary outcomes for clinician-rated and self-rated ADHD symptoms. Treatment effect of primary outcomes was maintained at follow-up, which suggests robust and lasting findings. In contrast to the primary outcomes, the secondary outcomes showed significant improvement over time.

Conclusions: The study provides evidence for the effectiveness of R&R2ADHD and demonstrates that there are differential effects over time for ADHD symptoms versus co-morbid problems, the latter taking longer to show positive effects.

Mentions:
Of 187 referrals, 73 (39%) were received from private practice psychiatrists, 56 (30%) were referred by psychiatrists, psychologist or psychiatric nurses at the Mental Health Services at Landspitali University Hospital and 56 (30%) were referred from advertisements to the members of the Icelandic ADHD Association. Out of the 187 referrals, 95 (51%) participants took part in the study. Fig. 1 presents the reasons for non-participation, the most common being declining to participate (n = 30), not contactable (n = 18) and stopped medication (n = 16). Of the participants, 11 were excluded because at the study intake interview (conducted by an experienced mental health practitioner) they were not diagnosed with ADHD [according to Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria]; 62 of the participants were female (mean age = 35.00, s.d. = 11.81 years) and 33 were male (mean age = 35.45, s.d. = 11.62 years).Fig. 1.

Mentions:
Of 187 referrals, 73 (39%) were received from private practice psychiatrists, 56 (30%) were referred by psychiatrists, psychologist or psychiatric nurses at the Mental Health Services at Landspitali University Hospital and 56 (30%) were referred from advertisements to the members of the Icelandic ADHD Association. Out of the 187 referrals, 95 (51%) participants took part in the study. Fig. 1 presents the reasons for non-participation, the most common being declining to participate (n = 30), not contactable (n = 18) and stopped medication (n = 16). Of the participants, 11 were excluded because at the study intake interview (conducted by an experienced mental health practitioner) they were not diagnosed with ADHD [according to Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria]; 62 of the participants were female (mean age = 35.00, s.d. = 11.81 years) and 33 were male (mean age = 35.45, s.d. = 11.62 years).Fig. 1.

Bottom Line:
Primary outcomes were rated by clinicians blind to treatment condition assignment.Treatment effect of primary outcomes was maintained at follow-up, which suggests robust and lasting findings.In contrast to the primary outcomes, the secondary outcomes showed significant improvement over time.

Affiliation:
Division of Brain Sciences,Department of Medicine,Centre for Mental Health,Imperial College London,London,UK.

ABSTRACT

Background: Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by high rates of co-morbid psychopathology. Randomized controlled trials of multimodal interventions, combining pharmacological and psychological treatments, have shown a robust treatment effect for ADHD symptoms but outcomes for co-morbid symptoms have been mixed. This may be accounted for by the type of intervention selected and/or by methodological problems including lack of follow-up and low power. The current study addressed these limitations in a parallel-group randomized controlled trial conducted in Iceland.

Method: A total of 95 adult ADHD patients who were already being treated with medication (MED) were randomly assigned to receive treatment as usual (TAU/MED) or 15 sessions of cognitive-behavioural therapy (CBT/MED) using the R&R2ADHD intervention which employs both group and individual modalities. Primary measures of ADHD symptoms and severity of illness, and secondary measures of anxiety, depression and quality of life were given at baseline, end of treatment and 3-month follow-up. Primary outcomes were rated by clinicians blind to treatment condition assignment.

Results: CBT/MED showed overall (combined outcome at end of treatment and 3-month follow-up) significantly greater reduction in primary outcomes for clinician-rated and self-rated ADHD symptoms. Treatment effect of primary outcomes was maintained at follow-up, which suggests robust and lasting findings. In contrast to the primary outcomes, the secondary outcomes showed significant improvement over time.

Conclusions: The study provides evidence for the effectiveness of R&R2ADHD and demonstrates that there are differential effects over time for ADHD symptoms versus co-morbid problems, the latter taking longer to show positive effects.